Child mortality according to maternal and infant HIV status in Zimbabwe
Child mortality according to maternal and infant HIV status in Zimbabwe
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DOI：
10.1097/01.inf.0000264527.69954.4c
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发表时间：
2007-06-01
影响因子：
3.6
通讯作者：
Ward, Brian J.
中科院分区：
文献类型：
--
作者：
Marinda, Edmore;Humphrey, Jean H.;Ward, Brian J.
背景资料：艾滋病毒导致非洲儿童的死亡率很高，但关于母婴感染状况和感染时间对死亡率的影响的数据有限。方法：参加ZVITAMBO试验的儿童分为5组：艾滋病毒抗体阴性母亲所生子女（NE，n = 9510），由HIV阳性母亲所生但未感染者（NI，n = 3135）、子宫内感染者（IU，n = 381）、产时感染者（IP，n = 508）和产后感染者（PN，n = 258）。结果：2年病死率分别为NE组2.9%、NI组9.2%、IU组67.5%、IP组65.1%、PN组33.2%。在8周至6个月之间，lU婴儿的死亡率增加了5倍（从309/1000 c-y增加到1686/1000 c-y）。IU、IP和PN婴儿从感染到死亡的中位时间分别为208、380和>500天。在NI儿童中，晚期孕产妇疾病是死亡率的预测因素。急性呼吸道感染是死亡的主要原因。结论：围产期感染的婴儿在2至6个月之间的死亡风险特别高：复方新诺明预防和早期儿科HAART应扩大。受感染母亲所生的未受感染婴儿的死亡风险至少是未受感染母亲所生婴儿的两倍：应针对所有接触艾滋病毒的婴儿采取儿童生存干预措施。艾滋病毒抗体呈阳性的母亲病情较重，不仅更有可能感染婴儿，而且婴儿无论是否感染都更有可能死亡：向孕妇和哺乳期妇女提供抗逆转录病毒治疗是母亲及其子女的迫切需要。
Background: HIV causes substantial mortality among African children but there is limited data on how this is influenced by maternal or infant infection status and timing.Methods: Children enrolled in the ZVITAMBO trial were divided into 5 groups: those born to HIV-negative mothers (NE, n = 9510), those born to HIV-positive mothers but noninfected (NI, n = 3135), those infected in utero (IU, n = 3 8 1), those infected intrapartum (lP, n = 508), and those infected postnatally (PN, n = 258). Their mortality was estimated.Results: Two-year mortality was 2.9% (NE infants), 9.2% (NI), 67.5% (IU), 65.1% (IP), and 33.2% (PN). Between 8 weeks and 6 months, mortality in lU infants quintupled (from 309 to 1686/1000 c-y). The median time from infection to death was 208, 380, and >500 days for IU, IP, and PN infants, respectively. Among NI children, advanced maternal disease was predictive of mortality. Acute respiratory infection was the major cause of death.Conclusions: Perinatally infected infants are at particular risk of death between 2 and 6 months: cotrimoxazole prophylaxis and early pediatric HAART should be scaled up. Uninfected infants of infected mothers have at least twice the mortality risk of infants born to uninfected mothers: all HIV-exposed infants should be targeted with child survival interventions. HIV-positive mothers with more advanced disease are not only more likely to infect their infants, but their infants are more likely to die, whether infected or not: provision of antiretroviral treatment to pregnant and lactating women is an urgent need for both mothers and their children.